Impact of Baseline Characteristics on the Effectiveness of Disorder-Specific Cognitive Behavioral Analysis System of Psychotherapy (CBASP) and Supportive Psychotherapy in Outpatient Treatment for Persistent Depressive Disorder
Importance: In the treatment of persistent depressive disorder (PDD), disorder-specific Cognitive Behavioral Analysis System of Psychotherapy (CBASP) has been shown to be superior to Supportive Psychotherapy (SP) in outpatients. It remains to clear which subgroups of patients benefit equally and dif...
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2020-12-01
|
| Series: | Frontiers in Psychiatry |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fpsyt.2020.607300/full |
| _version_ | 1818921942020784128 |
|---|---|
| author | Ilinca Serbanescu Matthias Backenstrass Matthias Backenstrass Sarah Drost Bernd Weber Bernd Weber Henrik Walter Jan Philipp Klein Ingo Zobel Martin Hautzinger Ramona Meister Martin Härter Elisabeth Schramm Dieter Schoepf Dieter Schoepf |
| author_facet | Ilinca Serbanescu Matthias Backenstrass Matthias Backenstrass Sarah Drost Bernd Weber Bernd Weber Henrik Walter Jan Philipp Klein Ingo Zobel Martin Hautzinger Ramona Meister Martin Härter Elisabeth Schramm Dieter Schoepf Dieter Schoepf |
| author_sort | Ilinca Serbanescu |
| collection | DOAJ |
| description | Importance: In the treatment of persistent depressive disorder (PDD), disorder-specific Cognitive Behavioral Analysis System of Psychotherapy (CBASP) has been shown to be superior to Supportive Psychotherapy (SP) in outpatients. It remains to clear which subgroups of patients benefit equally and differentially from both psychotherapies.Objective: To identify those patient-level baseline characteristics that predict a comparable treatment effectiveness of CBASP and SP and those that moderate the differential effectiveness of CBASP compared to SP.Design, setting and participants: In this analysis of a 48-week multicenter randomized clinical trial comparing CBASP to SP in adult antidepressant-free outpatients with early-onset PDD, we evaluated baseline variables from the following domains as potential predictors and moderators of treatment effectiveness: socio-demography, clinical status, psychosocial and global functioning, life quality, interpersonal problems, childhood trauma, treatment history, preference for psychotherapy, and treatment expectancy.Interventions: A 48-week treatment program with 32 sessions of either CBASP or SP.Main outcomes and measures: Depression severity measured by the 24-item Hamilton Rating Scale for Depression (HRSD-24) at week 48.Results: From N = 268 randomized outpatients, N = 209 completed the 48-week treatment program. CBASP completers had significantly lower post-treatment HRSD-24 scores than SP completers (meanCBASP=13.96, sdCBASP= 9.56; meanSP= 16.69, sdSP= 9.87; p = 0.04). A poor response to both therapies was predicted by higher baseline levels of clinician-rated depression, elevated suicidality, comorbid anxiety, lower social functioning, higher social inhibition, moderate-to-severe early emotional or sexual abuse, no preference for psychotherapy, and the history of at least one previous inpatient treatment. Moderator analyses revealed that patients with higher baseline levels of self-rated depression, comorbidity of at least one Axis-I disorder, self-reported moderate-to-severe early emotional or physical neglect, or at least one previous antidepressant treatment, had a significantly lower post-treatment depression severity with CBASP compared to SP (all p < 0.05).Conclusions and relevance: A complex multifactorial interaction between severe symptoms of depression, suicidality, and traumatic childhood experiences characterized by abuse, social inhibition, and anxiety may represent the basis of non-response to psychotherapy in patients with early onset PDD. Specific psychotherapy with CBASP might, however, be more effective and recommendable for a variety of particularly burdened patients compared to SP. |
| first_indexed | 2024-12-20T01:45:39Z |
| format | Article |
| id | doaj.art-21223a09500f481b9288cf81ffe6dc5f |
| institution | Directory Open Access Journal |
| issn | 1664-0640 |
| language | English |
| last_indexed | 2024-12-20T01:45:39Z |
| publishDate | 2020-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Psychiatry |
| spelling | doaj.art-21223a09500f481b9288cf81ffe6dc5f2022-12-21T19:57:46ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402020-12-011110.3389/fpsyt.2020.607300607300Impact of Baseline Characteristics on the Effectiveness of Disorder-Specific Cognitive Behavioral Analysis System of Psychotherapy (CBASP) and Supportive Psychotherapy in Outpatient Treatment for Persistent Depressive DisorderIlinca Serbanescu0Matthias Backenstrass1Matthias Backenstrass2Sarah Drost3Bernd Weber4Bernd Weber5Henrik Walter6Jan Philipp Klein7Ingo Zobel8Martin Hautzinger9Ramona Meister10Martin Härter11Elisabeth Schramm12Dieter Schoepf13Dieter Schoepf14Department of Clinical Psychology and Psychotherapy, University of Heidelberg, Heidelberg, GermanyDepartment of Clinical Psychology and Psychotherapy, University of Heidelberg, Heidelberg, GermanyInstitute of Clinical Psychology, Hospital Stuttgart, Stuttgart, GermanyDepartment of Psychiatry and Psychotherapy, Cognitive Behavioral Analysis System of Psychotherapy Center of Competence, University of Bonn, Bonn, GermanyInstitute of Experimental Epileptology and Cognition Research, University of Bonn, Bonn, GermanyCenter for Economics and Neuroscience, University of Bonn, Bonn, GermanyDepartment of Psychiatry and Psychotherapy, Charité-University Medicine Berlin, Berlin, GermanyDepartment of Psychiatry and Psychotherapy, Lübeck University, Lübeck, GermanyPsychology School at the Fresenius University of Applied Sciences Berlin, Berlin, GermanyDepartment of Psychology, Clinical Psychology and Psychotherapy, Eberhard Karls University Tübingen, Tübingen, Germany0Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany0Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany1Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, GermanyDepartment of Psychiatry and Psychotherapy, Cognitive Behavioral Analysis System of Psychotherapy Center of Competence, University of Bonn, Bonn, Germany2Department of Psychiatry and Psychotherapy, Vitos Weil-Lahn, Weilmünster, GermanyImportance: In the treatment of persistent depressive disorder (PDD), disorder-specific Cognitive Behavioral Analysis System of Psychotherapy (CBASP) has been shown to be superior to Supportive Psychotherapy (SP) in outpatients. It remains to clear which subgroups of patients benefit equally and differentially from both psychotherapies.Objective: To identify those patient-level baseline characteristics that predict a comparable treatment effectiveness of CBASP and SP and those that moderate the differential effectiveness of CBASP compared to SP.Design, setting and participants: In this analysis of a 48-week multicenter randomized clinical trial comparing CBASP to SP in adult antidepressant-free outpatients with early-onset PDD, we evaluated baseline variables from the following domains as potential predictors and moderators of treatment effectiveness: socio-demography, clinical status, psychosocial and global functioning, life quality, interpersonal problems, childhood trauma, treatment history, preference for psychotherapy, and treatment expectancy.Interventions: A 48-week treatment program with 32 sessions of either CBASP or SP.Main outcomes and measures: Depression severity measured by the 24-item Hamilton Rating Scale for Depression (HRSD-24) at week 48.Results: From N = 268 randomized outpatients, N = 209 completed the 48-week treatment program. CBASP completers had significantly lower post-treatment HRSD-24 scores than SP completers (meanCBASP=13.96, sdCBASP= 9.56; meanSP= 16.69, sdSP= 9.87; p = 0.04). A poor response to both therapies was predicted by higher baseline levels of clinician-rated depression, elevated suicidality, comorbid anxiety, lower social functioning, higher social inhibition, moderate-to-severe early emotional or sexual abuse, no preference for psychotherapy, and the history of at least one previous inpatient treatment. Moderator analyses revealed that patients with higher baseline levels of self-rated depression, comorbidity of at least one Axis-I disorder, self-reported moderate-to-severe early emotional or physical neglect, or at least one previous antidepressant treatment, had a significantly lower post-treatment depression severity with CBASP compared to SP (all p < 0.05).Conclusions and relevance: A complex multifactorial interaction between severe symptoms of depression, suicidality, and traumatic childhood experiences characterized by abuse, social inhibition, and anxiety may represent the basis of non-response to psychotherapy in patients with early onset PDD. Specific psychotherapy with CBASP might, however, be more effective and recommendable for a variety of particularly burdened patients compared to SP.https://www.frontiersin.org/articles/10.3389/fpsyt.2020.607300/fullpersistent depressive disorderCBASPsupportive psychotherapymoderator analysispredictor analysischildhood trauma |
| spellingShingle | Ilinca Serbanescu Matthias Backenstrass Matthias Backenstrass Sarah Drost Bernd Weber Bernd Weber Henrik Walter Jan Philipp Klein Ingo Zobel Martin Hautzinger Ramona Meister Martin Härter Elisabeth Schramm Dieter Schoepf Dieter Schoepf Impact of Baseline Characteristics on the Effectiveness of Disorder-Specific Cognitive Behavioral Analysis System of Psychotherapy (CBASP) and Supportive Psychotherapy in Outpatient Treatment for Persistent Depressive Disorder Frontiers in Psychiatry persistent depressive disorder CBASP supportive psychotherapy moderator analysis predictor analysis childhood trauma |
| title | Impact of Baseline Characteristics on the Effectiveness of Disorder-Specific Cognitive Behavioral Analysis System of Psychotherapy (CBASP) and Supportive Psychotherapy in Outpatient Treatment for Persistent Depressive Disorder |
| title_full | Impact of Baseline Characteristics on the Effectiveness of Disorder-Specific Cognitive Behavioral Analysis System of Psychotherapy (CBASP) and Supportive Psychotherapy in Outpatient Treatment for Persistent Depressive Disorder |
| title_fullStr | Impact of Baseline Characteristics on the Effectiveness of Disorder-Specific Cognitive Behavioral Analysis System of Psychotherapy (CBASP) and Supportive Psychotherapy in Outpatient Treatment for Persistent Depressive Disorder |
| title_full_unstemmed | Impact of Baseline Characteristics on the Effectiveness of Disorder-Specific Cognitive Behavioral Analysis System of Psychotherapy (CBASP) and Supportive Psychotherapy in Outpatient Treatment for Persistent Depressive Disorder |
| title_short | Impact of Baseline Characteristics on the Effectiveness of Disorder-Specific Cognitive Behavioral Analysis System of Psychotherapy (CBASP) and Supportive Psychotherapy in Outpatient Treatment for Persistent Depressive Disorder |
| title_sort | impact of baseline characteristics on the effectiveness of disorder specific cognitive behavioral analysis system of psychotherapy cbasp and supportive psychotherapy in outpatient treatment for persistent depressive disorder |
| topic | persistent depressive disorder CBASP supportive psychotherapy moderator analysis predictor analysis childhood trauma |
| url | https://www.frontiersin.org/articles/10.3389/fpsyt.2020.607300/full |
| work_keys_str_mv | AT ilincaserbanescu impactofbaselinecharacteristicsontheeffectivenessofdisorderspecificcognitivebehavioralanalysissystemofpsychotherapycbaspandsupportivepsychotherapyinoutpatienttreatmentforpersistentdepressivedisorder AT matthiasbackenstrass impactofbaselinecharacteristicsontheeffectivenessofdisorderspecificcognitivebehavioralanalysissystemofpsychotherapycbaspandsupportivepsychotherapyinoutpatienttreatmentforpersistentdepressivedisorder AT matthiasbackenstrass impactofbaselinecharacteristicsontheeffectivenessofdisorderspecificcognitivebehavioralanalysissystemofpsychotherapycbaspandsupportivepsychotherapyinoutpatienttreatmentforpersistentdepressivedisorder AT sarahdrost impactofbaselinecharacteristicsontheeffectivenessofdisorderspecificcognitivebehavioralanalysissystemofpsychotherapycbaspandsupportivepsychotherapyinoutpatienttreatmentforpersistentdepressivedisorder AT berndweber impactofbaselinecharacteristicsontheeffectivenessofdisorderspecificcognitivebehavioralanalysissystemofpsychotherapycbaspandsupportivepsychotherapyinoutpatienttreatmentforpersistentdepressivedisorder AT berndweber impactofbaselinecharacteristicsontheeffectivenessofdisorderspecificcognitivebehavioralanalysissystemofpsychotherapycbaspandsupportivepsychotherapyinoutpatienttreatmentforpersistentdepressivedisorder AT henrikwalter impactofbaselinecharacteristicsontheeffectivenessofdisorderspecificcognitivebehavioralanalysissystemofpsychotherapycbaspandsupportivepsychotherapyinoutpatienttreatmentforpersistentdepressivedisorder AT janphilippklein impactofbaselinecharacteristicsontheeffectivenessofdisorderspecificcognitivebehavioralanalysissystemofpsychotherapycbaspandsupportivepsychotherapyinoutpatienttreatmentforpersistentdepressivedisorder AT ingozobel impactofbaselinecharacteristicsontheeffectivenessofdisorderspecificcognitivebehavioralanalysissystemofpsychotherapycbaspandsupportivepsychotherapyinoutpatienttreatmentforpersistentdepressivedisorder AT martinhautzinger impactofbaselinecharacteristicsontheeffectivenessofdisorderspecificcognitivebehavioralanalysissystemofpsychotherapycbaspandsupportivepsychotherapyinoutpatienttreatmentforpersistentdepressivedisorder AT ramonameister impactofbaselinecharacteristicsontheeffectivenessofdisorderspecificcognitivebehavioralanalysissystemofpsychotherapycbaspandsupportivepsychotherapyinoutpatienttreatmentforpersistentdepressivedisorder AT martinharter impactofbaselinecharacteristicsontheeffectivenessofdisorderspecificcognitivebehavioralanalysissystemofpsychotherapycbaspandsupportivepsychotherapyinoutpatienttreatmentforpersistentdepressivedisorder AT elisabethschramm impactofbaselinecharacteristicsontheeffectivenessofdisorderspecificcognitivebehavioralanalysissystemofpsychotherapycbaspandsupportivepsychotherapyinoutpatienttreatmentforpersistentdepressivedisorder AT dieterschoepf impactofbaselinecharacteristicsontheeffectivenessofdisorderspecificcognitivebehavioralanalysissystemofpsychotherapycbaspandsupportivepsychotherapyinoutpatienttreatmentforpersistentdepressivedisorder AT dieterschoepf impactofbaselinecharacteristicsontheeffectivenessofdisorderspecificcognitivebehavioralanalysissystemofpsychotherapycbaspandsupportivepsychotherapyinoutpatienttreatmentforpersistentdepressivedisorder |